Microblading and shading Consent Form

Microblading and shading Consent Form

Helium salon
Client Information
Name *

First Name Last Name
Age *
Birth Date *

Month Day Year
Date
Phone Number *
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Pre-Procedure Questionnaire
Do any of the following pertain to you? *

Pregnant or nursing Diabetic Skin diseases Botox in the last 2 months Accutane in the last 6 months Blood thinners Pain intolerant Epileptic Autoimmune disease Cancer, Or had Chemo therapy or radiation HIV Chemical Peels in the last month Heart conditions Hepatitis Keloid scars Alopecia
If you selected anything from above, please explain:
If yes, please identify the condition.
Would you consider your skin: *

Very oily oily dry combination
Do you have any previous permanent make up and or microblading on your eyebrows? *

yes no
Do you have a preferred artist? *

first available Renata Sierra
Signed Date *

Month Day Year
Date
Client Signature *

Clear

In order to book a consultation we do require a $50 deposit. Should you book a treatment with one of our artist the $50 will be applied to your deposit. However if you choose to not book an appointment the cost of the consultation is $50 and non refundable.
Please upload a picture of your eyebrows, with no make up on. *

Cancel of

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